Arthroplasty Case Studies

On 3/27/2016, Ms. Hoover was seen in the ED at Norman Healthplex Hospital for right knee and upper calf pain, with minimal swelling. There was no history of trauma but she stated that she recently stopped Coumadin and was on injectable Lovenox in anticipation of her elective eye surgery. On examination, she was noted to have discomfort in the medial posterior aspect of the right knee, and reproducible upper right calf discomfort with palpation. Anteroposterior, lateral, and sunrise view radiographs of the right knee were requested which did not show any fracture or dislocation. Her total right knee arthroplasty prosthesis was in anatomic alignment. An ultrasound of the right lower extremity was also performed, with no evidence of deep venous thrombosis noted. She was given one 8 mg dose of intramuscular morphine. She was discharged by Marcia Hoos-Reinke, MD …show more content…
Hoover returned to Norman Healthplex Hospital on 3/30/3016, two days after her elective eye surgery. She was seen by Ryan Wilson, DO who noted that there was considerable swelling of her right lower extremity primarily in the medial thigh region, with several ecchymoses. She was given one 4 mg dose of morphine and one 4 mg dose of ondansetron intravenously. Her complete blood count showed severe anemia (hemoglobin 5.6, hematocrit 17.4) and an elevated white blood cell count (13.7). Her BUN (59), creatinine (3.27), glucose (218) and total CK (834) levels were elevated while her estimated GFR (18) and albumin (3.1) levels were low. The occult blood test was positive. Orders for inpatient admission, transfusion of two units of packed red blood cells, and referrals to cardiology, orthopedic surgery, gastroenterology, were given. The admitting diagnoses were: hematoma and contusion on the right lower extremity, unspecified gastrointestinal hemorrhage, and unspecified anemia. (Norman Regional Health System 2